For once I’ve a good
reason for being negligent about my blog. Pain is a mighty nuisance. It’s also thought-provoking.

Last year in September I
was climbing the stairs to my office on the 7th floor when I began
to hear a clicking sound in my left knee. As the clicking got louder, so did the
sensation of a tentacle sliding around in there. I went to the doctor. He
recommended leg lifts to strengthen the quadricep muscles that support the knee.
When I did these, my back hurt. I went back to him. He said the problem was
minor and I should keep doing the exercises, and if after a few weeks, the
problem didn’t go away, I should get an x-ray. It didn’t go away; I got an
x-ray. He said the x-ray was normal, and, yep, keep doing the exercises. By now
it was mid-October. The problem had been ongoing for about 5-6 weeks. Climbing
stairs to the sound of that whipping tentacle was becoming routine, as was knee
pain, as was swelling in my leg if I sat for more than ten minutes. The Dr.
prescribed Ibuprofen for the swelling but I had a reaction to it and the
swelling grew worse. And then one day, on a pebbly walkway in Lyon Arboretum, the
pain was just too severe to go on. I called the Dr. again. He
said he’d refer me to an orthopedist. I waited over a week. Eventually, Dave
had to call the doctor’s office and yell at them to hurry up and get the
referral; the referral came. Thank you hubby, but damn you, world, for listening
more to men.

I’ll try to make the rest
quick. The orthopedist said the x-ray wasn’t normal. My left patella, or knee
cap (you have to admit, patella has a ring to it), had tilted way out of its
groove. He showed me the image; the knee cap looked like a tiny saucer
teetering at a steep angle over the right lip of a small cup. How’d it get
there? Most likely, I was born with imperfectly positioned knee caps; my right
patella also tracks at a diagonal. But on the left side, the angle had become extreme. Why? I still don’t know. It might be that just a month earlier,
I’d gotten a US driver’s license and begun to drive in hilly Honolulu, forcing
the clutch knee to work over-time. Our car – my first ever! – is a Honda Fit;
zippy and nicely-sized but with pedals that rise too far off the floor for me.
My left leg was never comfortable while driving. Or it could be the gym, where
I’d begun to use elliptical machines a little manically. Or yoga. Qui sait? The
bottom line, well, my knee cap wasn’t tracking
properly, thus straining the tendons and causing the quadricep muscles to atrophy.
He recommended physical therapy. He also gave a steroid injection to bring the
swelling down.

I promise I’ll make the
rest quick. The day after the injection I had trouble raising my left leg at
all. Where before I could climb stairs – albeit with sound and fury – now I
just couldn’t lift the leg. Stairs were impossible, but so was just plain
walking. I mean, I couldn’t even walk over a television wire. I couldn’t sleep.
Absolutely no position worked. I was terrified and angry. By the time I saw the
physical therapist (in November), she said it was the worst case of patellofemoral
pain syndrome (PFPS) she’d ever seen. The knee cap was completely stuck. It was
no longer teetering at that precarious angle but completely fixed in it. The
muscles of my left thigh were gone. She was also the only one to admit that
sometimes a steroid injection isn’t the right choice – it can damage connective
tissues, like cartilage – though, and I’ll concede this grudgingly, when
Ibuprogen and other NSAIDs can’t be had, it does bring the swelling down. But
so does ice. Neither the general physician nor the orthopedist told me to ice,
not even once. The therapist added that she tells her patients to first try ice
and PT without the shot. So to anyone out there with similar symptoms reading
my blog, first see if you can ice, rest, and exercise without an injection.

But to go on (okay, I
admit I can’t be quick), I couldn’t do the exercises, even after the shot,
because my back hurt too much. Turns out my right hip rides higher than my
left. Like the position of my knee caps, this “abnormality” has probably been
there for some time, but because the knees carry the back, with one knee out,
the misalignment in my back had become more problematic. For most of December,
the therapist worked on improving the alignment of my back. Her technique was
interesting. I’d lie on my stomach and she’d ask me to cough. Each time I
coughed she pulled my right leg and this brought the hip into place. It worked
for a few days, but then the right hip would climb up again. Needless to say,
the pain sucked. Plus, my right knee
had begun to hurt as well. With the left knee and back not working properly,
the right knee was compensating – and protesting.

By February the therapist
conceded there were very few exercises I could do without aggravating my back
further, grossly slowing down improvement of the original problem –
petallofemoral pain syndrome – which by now had morphed to chondromalacia, or
the thinning of cartilage under and around the patella. I also developed knee
bursitis, or the swelling of the
bursae (fluid-filled sacs) around and behind the knee. Don’t you love these
fancy terms? (Bursitis behind the knee is especially hard to get rid of and
causes pain all the way down the back of the leg.) Most aggravating of all, my
mobility was still poor. Stairs were completely out. So was/is driving. (I
haven’t driven since last September.) Even bicycling, generally believed to be
excellent for the knee, had become difficult (and still is. On the downward
rotation, both knee caps stop tracking and start clicking). And I also
developed bursitis of the hips (and still have it).

Yet, around mid-March, I
did start noticing tiny – I mean really, really tiny – improvement. The left
patella had become a little looser and tracked a tiny bit less at that alarming
angle during certain activities like walking, or when I did leg lifts (not in
the position I was told to do them back in Sept). I could see a little more
muscle. I could do the leg lifts with weights. Kinesio tape also helped. From
February-late April I wore it in a “C” around both knees, and even now, I
sometimes have to tape up again when the tracking goes. I still ice daily,
including my lower back and around my hips. And I exercise diligently every day
– I’ve missed only two days from
November to this day in June. Today I have yet more muscle in my thigh, though
the back and pelvis are still quick to tweak. There are still many activities I
can’t do (like swimming; pure heartache, but the breast stroke is bad for the
knees and I can’t do the front crawl). I’ve had all manner of tests to check
for why recovery is so slow – MRIs and bone scans and x-rays of just about
everything. The good news: the tests are normal. The bad news: no one knows if
there’s an over-arching reason for it all.

I said at the beginning
that pain is thought-provoking. It is. I am never not shocked. How did I go
from being flexible, active, and lithe, to creaking like an old person? I’m not
going to be my mother and believe that this is a divine test. But I will notice
all those, both old and young, at the gym, on the beach, in lines at the
movies, or at work, who are just as frustrated as I am when the elevators don’t
work or when they can’t run or swim or squat. I also notice those who are
physically strong, particularly young women. And I compare them to the way I
was a year ago, or ten years ago, or thirty years ago.

In Pakistan, as a child,
I was never taught the importance of physical
strength, unless it had to do with eating more in order to be “healthy.”
Never exercise – though, without much prompting from others, I loved physical
activities and did what I could at school and other non-public places. There’s
so much paranoia about girls-in-public that by the time we’re in our teens,
even the lively ones grow sedentary, a habit made worse by very heavy
study-loads at school. Overall, sitting, either for tests and exams, or for
leisure and entertainment, is a favored local activity, and most of the ways
girls are taught to sit (cross-legged, for instance) are bad for us. No one
talks about keeping female joints healthy by building and sustaining muscle by being active from a young age. I’m not
blaming my frame on the way I was raised – I know a lot of it is just
body-type; I’m small and thin – though maybe I am, just a little. Because here
in Hawai’i, teenage girls are so, so much more active than Pakistani girls of
the same age -- swimming, dancing, bicycling, running – and I try to picture
them twenty or thirty years from now and I hope that if they end up with an
injury, including one they have no idea how they got, their bodies will allow
them to recover more quickly, and more fully. Ten years ago, when I completed Trespassing, I used this quote of John
Berger’s as an epigram: “To look is an act of choice.” I have started noticing
things I never noticed before.

About Me

I was born in Lahore and grew up mostly in Karachi, though I moved a lot as a child – two years in Tokyo, two in Manila, three in London. I wrote my first (complete) story at age six, and never stopped writing after that. In this photo, I’m on a suspension bridge in Hunza, in northern Pakistan, where part of my new novel, Thinner Than Skin, is set. I found the bridge on my way south from Passu to Gilgit. In case you’re in the area, you can also hazard the crossing by following this route.